Two small hospitals 25 miles from each other made a list of the 13 best rural hospitals in the nation and adminstrators said it has a lot to do with workplace culture and computers.

Infections and other preventable errors are becoming less common at Inland Hospital of Waterville and Sebasticook Valley Health of Pittsfield, two of the top 13 rural hospitals in the nation, according to an independent nonprofit group dedicated to improving health care.

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The group, Leapfrog, released the list after an analysis of public data on more than 200 hospitals showed that Inland and Sebasticook minimize hospital errors that hurt patients and increased health care costs.

Statistics from the national Centers for Disease Control show that hospitals give infections to 1.7 million patients a year, costing more than $30 billion.

Inland President John Dalton and Sebasticook President Victoria Alexander-Lane said workplace culture and computers are behind their success.

Workplace culture

“The fact that we continue to reduce errors, the fact that we’re essentially driving hospital-acquired infections out of this hospital, that’s the culture,” Dalton said.

Part of that is making peer interviews a big part of the hiring process.

“Our folks know right away, does this person care,” Dalton said. “Are they going to be part of our culture? Are they going to buy into this obsessive attention to trying to find out how to do better?”

Rick Barry, Inland’s vice president of patient care services, said staff members help screen out inferior candidates.

“If the staff tells the manager this person isn’t the right fit, the manager takes that seriously and we don’t bring that person in,” Barry said.

At Sebasticook, Alexander-Lane said job candidates are held to the hospital’s core values, even when it is difficult to fill a position.

“We have found ourselves in a position where we really needed somebody, and we’ve said ‘we haven’t found the person who meets the values,’ and we have gone without,” she said.

The values, including open communication, are applied equally to each employee, from the housekeepers to the board of directors, Alexander-Lane said.

Because of this, the days of close-minded doctors intimidating nurses and ignoring advice are over.

“We have zero tolerance for doctors who feel they don’t need to listen,” she said. “It’s important to have a good relationship between doctors and nurses which will result in nurses feeling empowered to speak up when they see something wrong.”

This is helped by a training program in which nurses receive specific instructions on what to say when calling a doctor about, for example, unexpected post-operative pain.

“I’ve see this happen and it’s frustrating,” Alexander-Lane said. “The nurse calls with inadequate information, the doctor becomes frustrated and is very busy and says, ‘go back and get that information’ or makes the decision without all the information. It doesn’t lead to a good relationship.”

Sebasticook workers also adhere to a set of principles originally developed at Toyota, according to Mike Peterson, chief administrative officer.

“The whole idea is, turning a staff into an army of people looking for problems to solve inevitably leads to solving a lot of problems,” he said.

Alexander-Lane said that projects suggested by employees at the hospital have led to reduced costs and higher efficiencies.

Projects have reduced the cost of printing employee paycheck stubs, made it easier for employees to purchase food from the cafeteria, among other cost reductions.

Barry said a demand for accountability at Inland also reduced the number of cases in which labor was induced in women before 39 weeks of pregnancy, one measure used by Leapfrog.

“There’s a lot of evidence that suggests that, for a standard, normal delivery, if you induce a patient before 39 weeks, there’s a greater choice of poor outcomes for the babies,” Barry said. “We had zero cases over the past year of inducing before 39 weeks.”

Dalton said the practice of inducing labor early is often done as a convenience, either for the patient or the provider.

“We just don’t believe in it,” he said. “We won’t do it.”

They did make one exception, a year and a half ago, because the baby’s father was about to be deployed to Afghanistan. The hospital induced labor 38 weeks and six days into the pregnancy — one day early.

“Even for that, we had significant discussion,” said Barry.

Computers

Because both Sebasticook and Inland are part of the Eastern Maine Healthcare System, they use similar advances.

A registration kiosk in Sebasticook’s lobby, for example, allows patients to check themselves in by inputting a unique code, Alexander-Lane said. When they do, the person they are there to see, like a blood lab technician, is automatically notified of the patient’s arrival, making for quicker contact between patient and provider.

At Inland, automated systems are becoming the norm, said Dalton.

“We actually have more computers here than we have employees,” he said.

Barry said the net effect is better patient outcomes.

“You’ve probably heard a lot of jokes about physicians’ handwriting not being the best,” said Barry. “For some people, trying to interpret physician handwriting is like trying to read hieroglyphics.”

Doctors and other providers at Inland now enter orders into a computer system, leaving no room for interpretation, Barry said. He said the same system walks the doctor through a checklist that ensures the best practices are considered for each patient.

“It helps to prevent working solely off of memory. Humans make mistakes,” Barry said. “They never do it on purpose, but sometimes you’re processing five or six things and you miss something.”

About a month ago, both hospitals started a new system that uses bar code technology to scan patient wristbands as medication is dispensed.

“It has caught errors,” Barry said. “This has caught things where maybe the pharmacy tech who was loading the machine put medication A into the slot for medication B. Then the nurse took it out of slot B to give the patient, and the machine caught the error.”

While advanced systems can help reduce human error, sometimes the solutions are decidedly low-tech.

Barry said that there is a set of errors called never events, or things that should never happen in a hospital. One never event is performing surgery on the wrong patient, or the wrong part of a patient’s body.

“If you come in for knee surgery on your right knee and we do it on your left knee, that’s a problem,” Barry said. “Unfortunately, that happens elsewhere in the country. That happens more than you might think.”

This doesn’t happen at Inland or Sebasticook, though, because of a simple solution. Before each surgery, a time out is called before the patient is put under anesthesia. During the time out, patient and physician each physically mark the site of the operation on the patient’s body.

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